2015 criteria for medically necessary mental health treatment available Jan. 1

Several medical necessity criteria for behavioral health treatment have recently been updated and will become effective on Jan. 1, 2015. At that time, you’ll be able to access them on web-DENIS.

For 2015, updates have been made to the following:

• The Magellan Behavioral Health Medical Necessity Criteria Guidelines,adapted for Blue Cross Blue Shield of Michigan. This document identifies the criteria for medically necessary psychiatric and substance abuse treatment.

• The BCBSM Behavioral Health Criteria Application Guidelines: These guidelines provide additional requirements and clarification for the use of the Magellan Behavior Health Medical Necessity Criteria and should be used in conjunction with these criteria where necessary.

• The medical necessity criteria for applied behavioral analysis and for repetitive transcranial magnetic stimulation.

As of Jan. 1, you can print or copy any of the above documents directly from web-DENIS. Follow these steps:

• Log in to web-DENIS.
• In the left-hand navigation, click on BCBSM Provider Publications and Resources.
• Click on Newsletters and Resources.
• Under “Other Resources,” click on Clinical Criteria & Resources.
• Scroll down to the Magellan Behavior Health Clinical Criteria section of the page and click on the document you wish to copy or print.

If you have any questions, please call Behavioral Health Services in the Ancillary Program Management department at 313-448-7745.